Re: A Vaccine to Save =?iso-8859-1?b?V29tZW6Scw==?= Lives
From: Joanne Bulley, MD (islesannie@gmail.com)
Wed Feb 7 19:40:42 2007
Thank you, Dean, for a very clear and precise discussion of this issus.
I agree with everything you say.
Jaonne
At Wed, 7 Feb 2007, Dean Huffman . wrote:
>
>..
>
>Clearly there are a number of issues with vaccination in general and this
>vaccination in particular. Some people feel that the vaccine is not yet “proven
>safe and effective” even though it has been released by the FDA. I suppose I can
>accept that arguement.
>
>Some say that the vaccine is not 100% effective. I will give them that. Probably
>no vaccine is 100% effective. But even partial effectiveness is partial
>protection.
>
>There is an issue of risk from a vaccine. Say 1 in 1000 persons dies from a
>disease, if not vaccinated and 1 in 1000000 die if they ARE vaccinated (some
>from the disease and some from the effects of the vaccine). Should the vaccine
>be given? Probably. Unfortunately, the 1 in 1000000 makes the lawyers drool.
>(Hence the federal legislation about childhood vaccinations.) This is an
>important issue in the debate about whether to give the Salk or Sabin polio
>vaccine. The Salk is very safe, but protection is less effective. Salk is given
>in the United States in order to protect the vaccinee. In other areas or the
>word, where polio is endemic, however, the Sabin (oral vaccine) is used because
>it offers better protection (at the risk of occasional vaccine induced polio)
>and the vaccine also protects those who are not vaccinated by secondary
>infection with the virus used in the vaccine.
>
>Another point is that vaccinations often are as protective for those who do not
>receive them as well for those who do. The oral polio vaccine is an example.
>For another example, if the people who had religious exemptions from the
>rubeola (measles) vaccine in Indiana had been vaccinated, the recent measles
>epidemic probably would not have occurred. First, the measles would not have
>been imported into Indiana from overseas because the index case would have been
>protected from contracting measles. Even if measles had been imported into the
>United States, there probably would not have been any secondary cases. Probably
>the best example of a vaccine intended to protect those other than the person
>receiving it is the rubella vaccine. It is intended solely to protect the
>unborn fetus. If it were not for congenital rubella syndrome, the rubella
>vaccine probably would not have been developed. Maybe a vaccine should be
>developed for parvovirus.
>
>Along those lines, the HPV vaccine probably should be given to boys, too, not so
>much to protect them (although there is evidence that it is protective in people
>receiving anal intercourse), but to protect the girls that they ultimately will
>have sexual intercourse with.
>
>An interesting concept would be to create liability for those who pass on a
>disease for which there is protection offered through vaccination, but who did
>not receive, or refused, the vaccination for other than medical reasons. (More
>lawyer drool.) Hence, maybe the families in Indiana who chose not to vaccinate
>their children should be liable for damages to anybody who contracted a
>secondary case of measles.
>
>Some feel that in Texas, at least, there may be a conflict of interest on the
>part of the governor in as much as he is apparently a stockholder in the
>vaccine producer (? Merck ?). I can understand that.
>
>I do take issue, however, with statements such as “ [my] … 9-yr-old daughter …
>is not at risk for [HPV], and not at risk for spreading same to ANYONE.” She
>might not be at risk TODAY, but if one thinks that one can control her daughter
>forever, that is vary naive thinking. Many, if not most, daughters will have
>sexual intercourse some time, either during high school, during college, or at
>some other time. The act of sexual intercourse will put her at risk. Even if
>she has sexual intercourse only in marriage, and only with her husband, she is
>still at risk for HPV. And it may well be too late at that time. In many
>respects, the vaccine will protect the girl against herself. She will almost
>never be as “pure” as her parents think. Waiting until the later teenage years
>or early adulthood might be too late to give protection to the young lady. The
>reason for suggesting that the vaccine should be given in the 9 – 11 year old
>age group is that this is the time when there is a very high probability that
>they have not yet been exposed to HPV and, hence, are able to be protected.
>Once they are exposed, it is too late.
>
>Thus, if the only reason one has to withhold the vaccination is that “my
>daughter will never be infected because she leads a moral life, and I will make
>sure that she continues to do so, and therefore does not need the vaccination”,
>then I submit that the parent is very naïve and is putting the child at
>unnecessary risk.
>
>I must admit that I have some problems with the governor of Texas making the
>vaccination mandatory. However, if the decision is left to parents whether or
>not to vaccinate (MMR, polio, tetanus, hepatitis B, etc., etc.) then far too
>many people will fail to be vaccinated and not only will they be at risk, but
>the benefits of herd immunity will also be lost. Much as I hate to say it, some
>people must be protected against themselves. The same argument can be made for
>other dangerous activities, such as not wearing seat belts, not using a helmet
>on a motorcycle, etc.
>
>Just my thoughts. As they say, I might be wrong (but I doubt it).
>
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--
Joanne Bulley, MD, FACOG
Solo gyn
Keene, NH USA
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